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Blog Update: Multistate E. coli outbreak- Source Found: Chopped Romaine Lettuce

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Infections Linked to Chopped Romaine Lettuce

This is an update of our previous blog 

The CDC and the FDA reported that their information indicated that chopped romaine lettuce grown in Yuma Arizona is probably the cause of the contamination with E. coli O157: H7. A common grower had not yet been identified.
As of April 12, 2018, 35 people from 11 states (Connecticut 2; Idaho 8; Illinois 1 Michigan 1; Missouri 1; New Jersey 7; New York 2; Ohio 2; Pennsylvania 9; Virginia 1; and Washington 1) were infected with the outbreak strain of E. coli O157:H7. Twenty-two ill people have been hospitalized, including three people who developed hemolytic uremic syndrome.
Epidemiologic data collected to date indicates that chopped romaine lettuce was the probable source of this outbreak. Twenty-six (93%) of 28 ill people that were interviewed reported consuming romaine lettuce in the week before their illness started. This percentage is significantly higher than results from common healthy people in which 46% reported eating romaine lettuce in the week before they were interviewed. Most of the interviewed people reported eating a salad at a restaurant, and romaine lettuce was the only common ingredient identified among the salads eaten. The restaurants reported using bagged, chopped romaine lettuce to make salads. At this time, ill people are not reporting eating whole heads or hearts of romaine.
Investigations are being conducted to find the source of the chopper romaine lettuce involved in the outbreak. A common grower or brand has not yet been identified. However, the data indicates that the chopped romaine lettuce was from the Yuma, Arizona growing region.  The Yuma region supplies romaine to the U.S. during November-March each year.
The current outbreak is not related to a recent multistate outbreak of E. coli O157:H7 infections linked to leafy greens reported in January this year. People in the previous outbreak were infected with a different DNA fingerprint of E. coli O157:H7 bacteria.
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Multi state E. coli outbreak- Source unknown and Investigation Underway

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The Outbreak

The CDC, the FDA, several states,  and U.S. Department of Agriculture’s Food Safety and Inspection Service are investigating a multistate outbreak of Shiga toxin-producing E. coli O157:H7 infections.
The investigation started by the New Jersey Department of Health, working together with the CDC and FDA. In New Jersey, ill people included in the outbreak had test results showing the presence of E. coli bacteria. Laboratory testing is ongoing to link their illnesses to the outbreak using DNA fingerprinting.
In this outbreak, there are currently 17 cases in 7 states: Connecticut (2), Idaho (4), Missouri (1), New Jersey (6), Ohio (1), Pennsylvania (2), and Washington (1). The 17 illnesses occurred until March 31, 2018. Six of those infected have been hospitalized, one of the hospitalized patients developed hemolytic uremic syndrome. Illnesses started on March 22, 2018, and data include cases that were diagnosed until March 31, 2018. The states associated with the outbreak are not clustered together, making a common source more difficult to find.
The investigation of the E. coli outbreak is still ongoing. To date, no specific food item, grocery store, or restaurant chain has been identified as the source of infections.  People that became ill are being interviewed by State and local public health officials, to determine what they eat and what they could have been exposed to in the weeks before getting ill.
PulseNet (the national sub-typing network) is being used to identify illnesses that might be part of this outbreak. E. coli bacteria isolated from ill people it tested using Pulse-Field-Gel (PFGE) and Whole Genome Sequencing (WGS). The DNA fingerprints obtained by PulseNet are used to identify possible outbreaks, and WGS gives a more detailed DNA fingerprint of the organisms. Some people may not be included in CDC’s case count because no bacterial isolates are available for the DNA fingerprinting needed to link them to the outbreak.

The Lawsuits are coming

Marler Clark from the Food Safety Law firm reports that his firm was retained by three patients affected in the multi-state E. coli outbreak. The clients reside in Idaho, New Jersey, and Pennsylvania. One client was hospitalized for three weeks after developing hemolytic uremic syndrome. Since the source of the outbreak is unknown, it is not clear who will be the target of the lawsuit.
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Salmonella in Kratom causes FDA to Orders Mandatory Recall

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Triangle Pharmanaturals mandatory Recall

The U.S. Food and Drug Administration (FDA) announced a mandatory recall for all food products containing powdered kratom manufactured, processed, packed, or held by Triangle Pharmanaturals LLC, (Las Vegas-based company) after several products were found to contain salmonella.
The products involved in the recall include Raw Form Organics Maeng Da Kratom Emerald Green, Raw Form Organics Maeng Da Kratom Ivory White, and Raw Form Organics Maeng Da Kratom Ruby Red.
Triangle Pharmanaturals manufacture, process, pack and/or hold additional brands of food products containing powdered kratom, including powder and encapsulated powder forms.   The forced recall follows Triangle Pharmanaturals, refusal to cooperate and voluntarily pull its products after they tested positive for Salmonella, the FDA said.
The agency statement said “This is the third time the FDA has started the process of using its mandatory recall authority, but the first time” it’s issued such an order due to a company rejected the voluntary recall request.
“Our first approach is to encourage voluntary compliance, but when we have a company like this one, which refuses to cooperate, is violating the law and is endangering consumers, we will pursue all avenues of enforcement under our authority,” FDA Commissioner Scott Gottlieb said.
“This action is based on the imminent health risk posed by the contamination of this product with salmonella, and the refusal of this company to voluntarily act to protect its customers and issue a recall, despite our repeated requests and actions,” said Dr. Gottlieb, M.D. “We continue to have serious concerns about the safety of any kratom-containing product and we are pursuing these concerns separately. But the action today is based on the risks posed by the contamination of this particular product with a potentially dangerous pathogen.”
The mandatory recall is the FDA’s first since it was given the authority to issue such an order for food products in 2011. Under the FDA Food Safety Modernization Act, the FDA has the authority to order the recall of food products when it determines that there is a reasonable probability that the article is adulterated and that its use could cause serious adverse health consequences or death to humans or animals.  Under the federal law, Dietary supplements are considered foods, not drugs. Two samples of kratom products manufactured by Triangle Pharmanaturals, and collected by the Oregon Public Health Division, tested positive for salmonella, as did four additional samples of various types of kratom product associated with the firm collected by the FDA.

What is Kratom?

Mitragyna speciosa, commonly known as kratom, is a plant that grows in Thailand, Malaysia, Indonesia and Papua New Guinea. The leaves of Kratom are used as an herbal drug by people of Southeast Asia.  Kratom leaves in low doses are used as a stimulant and at high doses as a sedative, recreational drug, pain killer, medicine for diarrhea, and treatment for opiate addiction.
The leaves can be chewed, dried and smoked, or powdered and consumed as a tea or in supplements. The product is promoted in the US as a way to treat muscle pain, diarrhea, and opiate withdrawal. Although it’s legal in the US, it’s illegal in some Southeast Asian countries.
The FDA would like people to avoid kratom or its psychoactive compounds, mitragynine, and 7-hydroxymitragynine, because there is substantial evidence that kratom affects the same opioid brain receptors as morphine and appears to have properties that expose people who consume it.

NutriZone recall Kratom

The FDA announced that NutriZone, LLC of Houston, Texas is recalling four different dietary supplements containing kratom due to contamination with Salmonella. The products were sold in Pennsylvania, Oklahoma, Washington, Missouri, Florida, Mississippi, California, and Texas.
The potential for contamination was noted after routine sampling and testing by the FDA revealed the presence of Salmonella. No illnesses have been reported to date in connection with this problem.

A multi-state outbreak of Salmonellosis linked to kratom

FDA Investigates Multistate Outbreak of Salmonella Infections Linked to Products Reported to Contain Kratom. On March 22, 2018, PDX Aromatics of Portland, Oregon, issued their second expanded recall in due to additional positive Salmonella samples associated with PDX Aromatics’ products. On March 23, 2018, Tamarack Inc.voluntarily recalled Eclipse kratom-containing powder products. These recalls are in addition to NutriZone, LLC of Houston and Triangle Pharmanaturals.
According to the Centers for Disease Control and Prevention (CDC), since late last month, 87 cases, in 35 states linked to kratom products have resulted in 27 hospitalizations. Epidemiological and laboratory data indicates the Kratom is the likely source of this outbreak. CDC reported a total of 87 people infected with outbreak strains of Salmonella I 4,[5],12:b:- (50), Salmonella Javiana (5), Salmonella Okatie (16), or Salmonella Thompson (16). Of 69 people with available information, 27 (39%) have been hospitalized. No deaths have been reported. Recent data showed additional strains including Salmonella Okatie, Salmonella Javiana, and SalmonellaThompson.
Of the 55 people interviewed, forty (73%) reported consuming kratom in pills, powder, or tea. Most people remembered consuming the powder form of kratom. The information collected about the purchasing location of kratom by the ill people, a single common brand or supplier of kratom has not been linked to the outbreak.
Most people infected recover without treatment, though the FDA said an unusually high number of people linked to the outbreak involving kratom were hospitalized.
Tests showed 26 different kratom products, from multiple manufacturers, were contaminated.
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Detection of bacterial growth and Biofilm formation in pipelines made easy

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By Giovanni Pavanello

The Biofilm Problems

On the surfaces that are in contact with water, a “biofilm” layer of microorganisms that are contained in a matrix (slime layer) can be formed. It is as a complex community of microorganisms, embedded in self-created extracellular polymeric substances (EPS). The biofilm is a microbial population adherent to each other and to the surfaces or interfaces enclosed in the matrix. Their presence in manufacturing pipelines can be responsible for a wide range of water quality and operational problems.
A Biofilm layer can form on any surface, even in extreme conditions (e.g., very high and very low pH values and temperature, in radioactive waters, even in space stations), and it causes a variety of problems:
  • Increase in the risk of pathogens – biofilm is the ideal environment for the proliferation of harmful bacteria by offering shelter and food;
  • Decrease in thermal efficiency of heat exchangers – for example, the biofilm is more insulating than calcium carbonate;
  • Microbiologically influenced corrosion (MIC) – also known as bacterial corrosion, it accounts for billions of dollars of industrial damages all over the world.
Large amounts of chemical substances (sanitizers, biocides, and disinfectants) are usually employed to prevent biofilm development in industrial piping systems. However, often they do not provide the expected results. In most cases, Clean-In-Place (CIP) and sanitation treatments are applied out on a regular basis (daily, or weekly) or when visible problems arise. The real need for neither the treatment nor its effectiveness is verified.
It is important to note that it is usually hard to take representative samples (“swabs”) from internal pipe surfaces. Standard plate counts applied to water samples are of limited use. Indeed, it is well known that bacterial growth on pipe surfaces is mostly unrelated to the presence/number of bacteria in the water. Planktonic (free-floating) bacteria attach to the pipes by the production of ESP; they multiply and form a mature biofilm, stabilizing the microcolony from environmental stress. Therefore, most bacteria live in biofilms, not free in the water.
Bacteria embedded in the biofilm are more difficult and expensive to eliminate, than free-floating planktonic bacteria. The extracellular substances (EPS) increase the bacterial resistance to external agents, by up to 1000x. As the biofilm matures, the ESP matrix becomes thicker. Thus it is much more resistant than an early-stage one. Sanitation and cleaning treatments should be applied on early-phase biofilm, to obtain the best results.
Moreover, when the biofilm is mature, its outermost layers tend to detach and float away. In these cases, it increases the likelihood of biofilm formation in other areas of the piping system.

The ALVIM Biofilm Monitoring System

Innovative technology for the detection of biofilms was developed by ALVIM, an Italian Company, in collaboration with the Italian National Research Council.
By measuring bacteria bio-electrochemical activity (a phenomenon known as “ennoblement” or “cathodic depolarization”), the ALVIM technology detects biofilm formation since its first phases, online and in real time. The technology allows checking the effectiveness of CIP and sanitation treatments, without the need for water sampling and lab analyses.   An example, from a reverse-osmosis (RO) system, is illustrated in the graph on the right. As it can be seen in the figure, the user can decide when to apply CIP, checking in real time if biofilm was actually removed.
The system helps in keeping track of bacterial settlement and growth inside water lines, tanks, and other surfaces in contact with the water and other liquids allowing checking, simultaneously, the efficacy of sanitation treatments.
The ALVIM probes are more specific than other sensors since they detect bacterial fouling (biofilm formation), not other kinds of deposit, such as minerals, proteins, fats, etc. This is extremely important since different fouling types require different treatments. It is important to emphasize that the ALVIM sensors are very sensitive to the detection of biofilm in its initial colonization phase, the best time to apply CIP and sanitation treatments.
ALVIM biofilm probes are currently used worldwide, in applications ranging from Cooling Towers to Food and Beverage, Paper Production, Oil and Gas and others, including large international Companies like Total, GDF Suez (ENGIE) and Danone.
The Massachusetts Institute of Technology (MIT) used ALVIM probes, in a Project regarding water distribution systems, and the European Defence Agency (EDA) indicated ALVIM Technology as a promising solution to the cleaning of biofilms. Overall, the ALVIM Technology allows for a simple and flexible approach to biofilm monitoring, considering different applications such as:
  • Analysis and characterization of biofilm growth;
  • Assessment and comparative evaluation of different chemical biocides, CIP and sanitation treatments;
  • Real-time, continuous monitoring of water treatment systems;
  • Automatic and/or remote control and optimization of sanitation treatment;
  • Effective prevention of pathogens, like Legionella, Listeria and Staphylococcus
 
More info available at: http://www.alvimcleantech.com/cms/en/biofilmsensors 
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Salmonella Alert: Triple Meats Recalls Chicken Salad Products Sold At Fareway

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On February 9, 2018, the Food Safety and Inspection Service (FSIS) was notified by Iowa health officials about an investigation regarding Salmonella Typhimurium illnesses. The health authorities linked the outbreak with chicken salad sold in Fairway stores.
On February 14, 2018, the FSIS issued the first alert relating to potential Salmonella contamination in chicken salad sold at Fareway grocery stores. 
On February 21, 2018, the U.S. Department of Agriculture’s Food Safety (USDA) and Inspection Service (FSIS) announced the recall of Triple T Specialty Meats Inc., from Ackley Iowa, of approximately 20,630 pounds of ready-to-eat chicken salad products that may have been contaminated with Salmonella Typhimurium.
The FSIS/USDA announcement stated that based on an epidemiological investigation, the onset of the illnesses was from January 4, 2018, to February 9, 2018. The products were sold in the grocery store in various containers from the deli department.
The Center for Disease Control (CDC) issued their initial report on February 21, 2018.  The CDC reported that the recalled chicken salad was sold in Illinois, Iowa, Minnesota, Nebraska, and South Dakota from January 4, 2018, to February 9, 2018.
Epidemiological data indicated that the chicken salad produced by Triple T Specialty Meats Inc. and sold at Fareway grocery stores is the likely source of this multistate outbreak. 78% of the interviewed ill people reported eating chicken salad from Fareway.  65 people from 5 states were infected by the strain of Salmonella Typhimurium. 28 of the infected people were hospitalized, but no death reported.
Whole genome sequencing (WGS) of bacteria from the affected people indicated that the infected people were likely to share a common source of infection.  As can be seen in the chart, the illness started on January 8th and continued until February 10th. Some illnesses that happened after February 5 might not yet be reported.
Fareway Stopped selling the chicken salad on February 9th. However, only on February 21, 2018, did Triple T Specialty Meats, Inc. recall all chicken salad produced from January 2, 2018, to February 7.
Meanwhile, four lawsuits have been filed related to the chicken salad produced by Triple Meats and Sold by Fareway were filed by Marel Clark, the Food Safety Law Firm.  All complaints are against Triple meats and Fareway.
According to the complaint, Jeff Anderson purchased Fareway Chicken Salad on February 1, 2018, from the Fareway store in Moline, Illinois. He consumed the product on February 1 -2, 2018. On Sunday, February 4, Jeff became ill with diarrhea, body aches, and chills. His symptoms became so severe that Jeff required emergency medical attention on February 6, 2018.
Derek Porter and his wife Sarah from South Dakota, purchased Fareway Chicken Salad on February 8, 2018, from the store in Harrisburg, South Dakota. On Sunday and Monday—February 11th and 12th—both Derek and Sarah became ill with diarrhea and abdominal cramping. Both continued to suffer bouts of headache, stomach cramps, and diarrhea until Derek took Sarah to the Emergency Room at about 1:30 AM on Valentine’s Day, February 14th.
James Fox resides in the city of Grimes. He purchased a Fareway Chicken Salad product on February 2, 2018, from the Fareway store located in Grimes, Iowa, and consumed it on the same day. On Sunday, February 4, 2018, Mr. Fox became ill with diarrhea, chills, and fever. His symptoms became so severe that he required emergency medical attention on February 7, 2018.   This case again demonstrates the impact of slow recall of products. By the time that the recalls were issued on February 21, 2018, most of the infections had occurred, and the product was no longer on the market.  The vast majority of the victims of this infection were already on their way to recovery.
The case also demonstrates how expensive it is for manufacturers to have a Salmonella infection in their products.
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Dog Foods in the News: Recalls for Salmonella, Listeria and Illegal Drug

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In February a number of dog food brands were recalled.  The recalls were due to bacterial contamination (Salmonella and Listeria) as well as the presence of an illegal drug.

Recalls due to Bacterial Contamination

In February, Salmonella contamination appeared in four different dog food products, prompting the Food and Drug Administration (FDA) to announce the recall of these products.   Salmonella can cause illness in pets, but it can also cause the pets to become carriers infecting humans.  The companies recalling dog food include:

Raws Paws (Minneapolis, MN)

On February 8th the FDA announced the recall of ~ 4,000pounds of 5 lb. and 1 lb. sealed plastic tubes (chubs) of Ground Turkey Pet Food, due to Salmonella.  The product was distributed throughout Minnesota, Wisconsin, and Iowa directly to consumers and through online mail orders.
 The contamination of some packages of Turkey Pet Food was detected in testing by the Minnesota Department of Agriculture (MDA). Two illnesses (in the same household) have been reported to date in connection with this problem.

Smokehouse Pet Products, Inc. (Sun Valley, CA) 

On February 8th the FDA announced the recall of 4-oz bags of dog treats labeled as “Beefy Munchies”, due to Salmonella. The recall was expanded on February 15th to include all sizes of Smokehouse’s Beefy Munchies.
 The products were distributed in Washington, Michigan, North Carolina and Colorado through distributors selling to various retailers. No illness has been reported to date. The contamination was detected in two packages of 4 oz. Beefy Munchies in routine testing by the Colorado Department of Agriculture.

Redbarn Pet Products, LLC (Long Beach, CA) 

On February 9th the FDA announced the recall of Redbarn’s 7-inch Bully Stick packs 2.4 ounce, green plastic bag due to Salmonella. The recalled products were distributed in pet specialty retail stores. 
According to the FDA, the company President Jeff Sutherland explained: “On 2/5/2018, we were notified by the Colorado Department of Agriculture that a single sample collected from a retail location detected Salmonella. At Redbarn, we test every product lot before it leaves our manufacturing plant. This lot code was tested both at our Redbarn lab and by a third-party testing facility. Those tests were negative for salmonella or pathogens. Despite not being able to replicate these test results or receiving any negative reports from customers regarding these chews, we feel the best course of action is to recall this lot code of the product and keep our customers safe”.  No illnesses, injuries or complaints have been reported.
 

Darwin’s Natural and ZooLogics pet foods (Tukwila, WA)

On February 13th the FDA investigated a pattern of contamination in raw pet foods made by Arrow Reliance Inc., which produced products for Darwin’s Natural Pet Products and ZooLogics Pet Food. From October 17th, 2016 to February  10th, 2018 there were four recalls of Darwin’s Natural Pet Products and ZooLogics Pet Food due to Salmonella and/or Listeria monocytogenes in samples of their raw pet food products.
The most recent recall (February 10th, 2018) was due to Salmonella in Duck with Vegetable Meals for Dogs and Chicken with Vegetable Meals for Dogs.  The FDA is investigating six complaints of illness and death of animals due to the consumption of the product. The dog food products were sold only online, and the customers were notified by email about the recall.  
The recent recall was triggered by a dog owner complaint. The dog had consumed the product and had recurring diarrhea over a nine-month period and tested positive for Salmonella.

Dog Food Contaminated with Pentobarbital

Pentobarbital is a sedative barbiturate drug that slows down the brain and the nervous system activity and used to euthanize animals. The presence of pentobarbital at any level in pet food is a violation of the U.S. Food and Drug Administration’s Federal Food, Drug, and Cosmetic Act.
On February 16, 2018, The  J.M. Smucker Company announced the recall of various canned dog food (Gravy Train, Kibbles ‘N Bits, Ol’ Roy, and Skippy canned products), since they contained an extremely low level of pentobarbital. The Company claims that it has identified the root cause to be a single supplier and a single minor ingredient used at a single manufacturing facility.
Barry Dunaway, President of Pet Food and Pet Snacks said: “We take this very seriously and are extremely disappointed that pentobarbital was introduced to our supply chain. We will continue to work closely with our suppliers and veterinarians to ensure the ingredients used in our products meet or exceed regulatory safety standards and our high-quality standards.”
The discovery of the product’s contamination was due to a study conducted by Clean Label Pet Food Project that tested 1,084 pet food products from 80 brands, screened for over 130 toxins including heavy metals, BPA, pesticides and other contaminants causing cancer and other health conditions in both humans and animals. In this study, the contamination was discovered in Gravy Train.
Clean Label Project Executive Director Jaclyn Bowen explained in an email: “One possible way [the drug got into the food] is through the use of contaminated ingredients, rendering plants take slaughterhouse animal tissues and convert them into stable, usable materials like purified fats such as lard or tallow… It is possible that animals exposed to pentobarbital were included in the rendering process.”